This document discusses alcohol withdrawal delirium (AWD), also known as delirium tremens or DTs. It defines delirium and describes different types. AWD is a serious form of alcohol withdrawal that causes sudden brain and nervous system problems. It only affects heavy drinkers who stop drinking abruptly. Symptoms include hallucinations, agitation, and disorientation. Diagnosis involves various medical tests. AWD is treated in hospitals with intravenous fluids, medications to prevent seizures and reduce symptoms, and rehabilitation. With treatment, AWD has a low death rate but some withdrawal symptoms may persist long-term.

1. WITHDRAWAL
DELIRIUM

2. DELIRIUM DEFINITION
• Delirium is defined as any acute disturbance in
cognitive functions which is always
accompanied by disturbance in consciousness.

3. Types of Delirium
• Hyperactive Delirium: In this type of delirium,
the patient is aggressive, agitated and pulling
out lines
• Hypoactive Delirium: this is only revealed by
signs of inattention and decreased awareness
of environment during close questioning.
• Mixed Form

4. Etiological classification – DSM-IV
• Delirium due to a general medical condition;
• Substance-induced delirium—including
medication side-effects;
• Delirium due to multiple aetiologies;
• Delirium not otherwise specified.

5. Alcohol Withdrawal Delirium
(Delirium Tremens)
• Alcohol withdrawal delirium (AWD) is the
most serious form of alcohol withdrawal. It
causes sudden and severe problems in your
brain and nervous system.
• AWD is also known as delirium tremens or
DTs. It is a medical emergency.

6. Epidemiology
• Approximately five percent of hospital
patients being treated for alcohol withdrawal
experience AWD.
• It has a greater propensity to develop in males
than females

7. CAUSES
AWD only affects people with a history of heavy
alcohol use. Heavy drinkers may develop this
condition if they:
• suddenly stop drinking
• reduce their alcohol use too quickly
• don’t eat enough when reducing alcohol use
• have a head injury
• are sick or have an infection

8. RISK FACTORS
• have been drinking heavily for a long time
• Age greater than 30 years
• have a history of alcohol withdrawal
• have a history of AWD
• have other health problems in addition to
alcoholism
• have brain damage

9. Symptoms of AWD
• Hallucinations
• Diaphoresis
• Agitation*
• Low grade fever
• Tachycardia*
• Hypertension*
• Disorientation

10. DIAGNOSIS
• Diagnosis of AWD involves physical examination
together with results of tests including:
• a toxicology screen to look for alcohol in your
blood
• blood tests to measure magnesium and phosphate
• a comprehensive metabolic panel
• an electrocardiogram (ECG) to check your heart
function
• an electroencephalogram (EEG) to record the
electrical activity in your brain

12. CIWA-Ar cont.
• Each of the manifestations in the previous
slide are noted on a scale of 0-7 according to
severity
• The maximum possible score is 67
• The level of treatment for alcohol withdrawal
will be dependent on the score obtained
• Patients scoring less than 9 usually do not
require additional medication

13. TREATMENT AWD
• AWD can be fatal. Therefore, treatment
should be received in a hospital and includes:
• intravenous fluids
• anticonvulsants to prevent or stop seizures
• sedatives to calm agitation and treat anxiety
• antipsychotic medications to prevent
hallucinations
• medication to reduce fever
• treatment for other alcohol related conditions
• rehabilitation to help you stop drinking

15. Prognosis of AWD
• AWD can be deadly. This is particularly true if it
remains untreated. Treatment significantly lowers
your risks of complications and death.
• With timely medical treatment, AWD has very
low death rate. However, some symptoms of
alcohol withdrawal may last for more than a year.
These include:
• Mood swings
• Fatigue
• Sleeplessness

16. THANK YOU